Dear Dr. Frascino, I am HIV+ for about 4 years and still not on meds. On my last checking, CD4 decreased from 690 from 3 months ago to 450. Viral load not changed and remains in the range of 40.000. Since I still had unprotected sex, I am fearing superinfection. I had similar simpthons of seroconversion of 4 years ago, including low fever and tiredness. In the meantime, I also acquired ameba during a trip to the far east. The ameba was now eliminated but I am still having occasional low fever and night sweat. My doctor says nothing to worry as we did not see an increase in the viral load. Because of my unstable temperature readings, plus the fact that the last CD5/VL checking was made just before my trip to Asia (so, assume prior to the ameba issue), I am quite confused and anxious. Do you think the fall of 250 points in the CD4 alone, without any change in the viral load, could indicate a superinfection or the viral load increase would be decisive for that diagnosis? Many thanks for your always clear advices.

Hello,

You have been HIV positive for four years, are not on medications and continue to have unprotected sex???? WHAT??? You seem to be only concerned that you may have acquired a superinfection. What about the risk you knowingly inflicted on your sex partners? Such behavior is unconscionable! Your doctor may say you have nothing to worry about, but I strongly disagree. You should be very worried that you transmitted your virus to your partners. I urge you to do the right thing and advise all your partners of your HIV status and encourage them to be screened for HIV. If, by chance, you've been "serosorting" (only having sex with other HIV positive folks), you are putting yourself at considerable risk for STDs (including another strain of HIV), which could negatively impact your health and exacerbate your HIV disease.

My primary message to you is to stop having unsafe sex and to notify any partners at risk. There are several reasons for a fall in CD4 counts (including your reckless behavior). I wouldn't draw any conclusions based on a single lab value, as it may be a transient anomaly. I'd recommend repeating your CD4 count and viral load in four to eight weeks to see if there is indeed a trend.

Dr. Bob